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Purpose – This study investigates the sociodemographics, late entry to antiretroviral therapy (ART), and clinical markers associated with AIDS-related mortality.

Methodology/Approach – Applying retrospective cohort design, 960 medical records of people who died of AIDS, from October 2006 to December 2014, were accessed from the ART center at tertiary health care center of Ranchi (India).

Findings – With useable data from 889 medical records revealed that the majority of people who died of AIDS consisted of married males in the age group of 19–40 years who were truck drivers, migrant laborers, and of rural origins. The median survival period was below 3 months following the ART. Males and people on the pre-ART group had a shorter survival period than their counterparts. Early mortality was associated with lower CD4+ T cell counts, the third or fourth clinical stage, ambulatory or bed-ridden functional status, and poor medication adherence.

Research limitations/implications – This study was limited to the analysis of AIDS deceased people only; it did not compare the survival duration with living people on ART. The lower CD4+ T cell counts and medication adherence, being strong predictors of mortality, can be addressed to attain higher survival rates of people who have AIDS.

Originality/Value of Paper – This is the first study conducted in the tribal-populated region, covering a large sample of 889 cases. Unique findings of this study update the existing data on AIDS-related mortality.

By bringing together aspects of sustainable forest management, population health, and local livelihoods, the purpose of this study was to characterize how household dependence on forest resources changes through three phases: the period before HIV became a problem in the household, the period during HIV-related morbidity, and after AIDS-related mortality.

Sixty semi-structured interviews were conducted with members of unaffected and HIV/AIDS-affected households in four case study districts in Malawi.

This study demonstrates that the relationship between HIV/AIDS and dependence on specific forest resources appears to correspond closely with the stage of the disease. Firewood and water were consistently ranked as being one of the three most important resources, regardless of HIV-affectedness. During the morbidity phase, respondents reported their need for medicinal plants increased substantially, along with other resources. The importance of timber increased significantly after HIV-related mortality.

Interview respondents themselves suggested key interventions that would assist households in the HIV/AIDS-mortality phase, in particular, to obtain the forest resources they require. These interventions could address the impacts of HIV/AIDS on the sustainability of important resources, compensate for a decreased availability of household labor, and foster greater access to these resources for vulnerable households in the four study sites.

In spite of the fact that forest resources can play a crucial role in enabling a household to control and adapt to the disease, research on the environmental dimensions of HIV/AIDS remains limited. This chapter helps to address this knowledge gap, suggests practical, innovative interventions that could alleviate some of the disease burden on rural Malawian households, and offers insight into potential areas of further inquiry in this research domain.

People in prison are at a higher risk of preventable mortality from infectious disease such as human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), hepatitis B (HBV), hepatitis C (HCV) and tuberculosis (TB) than those in the community. The extent of infectious disease-related mortality within the prison setting remains unclear. The purpose of this paper was to collate available information on infectious disease-related mortality, including the number of deaths and calculate the person-time death rate.

The authors searched databases between 1 January 2000 and 18 November 2020 for studies reporting HIV, HBV, HCV, TB and/or HIV/TB-related deaths among people in prison.

The authors identified 78 publications drawn from seven Joint United Nations Programme on HIV/AIDS’ regions encompassing 33 countries and reporting on 6,568 deaths in prison over a 20-year period. HIV/AIDS (n = 3,305) was associated with the highest number of deaths, followed by TB (n = 2,892), HCV (n = 189), HIV/TB (n = 173) and HBV (n = 9). Due to the limitations of the available published data, it was not possible to meta-analyse or in any other way synthesise the available evidence.

To inform targeted efforts to reduce mortality, there is a need for more, better quality data to understand infectious disease-related mortality in custodial settings. Increased investment in the prevention and management of infectious diseases in custodial settings, and in documenting infectious disease-related deaths in prison, is warranted and will yield public health benefits.

To the authors’ best knowledge, this is the first scoping review focussed on deaths due to these infections among people in prison internationally. The gaps identified form recommendations to improve the future collection and reporting of prison mortality data.

The purpose of this paper is to explain how international drug policy continues to have a hugely damaging effect on population health, human rights and wellbeing, not only on individuals who consume and/or sell drugs but also on societies as a whole. And to review whether anything has changed after United Nations General Assembly Special Session.

UNGASS had been seen as a real opportunity for scientific evidence to become the driver of future drug policy. This paper looks at any changes that have since taken place that might support such an aspiration.

The authors found the criminalisation and incarceration of people who use drugs, mainly from the most marginalised sections of society, remains the primary response in almost every member state of the UN and there are at least 33 countries that retain the death penalty for drug offences. The impact on the health of people who inject drugs (PWIDs) living with HIV is devastating and overdose and AIDS related mortality are the leading causes of death. Hepatitis C infections among PWIDs are increasing at epidemic levels even though this now a curable disease.

Changes in drug policy urgently needed.

This paper is an important review of the health implications of bad drug policy.

For decades, northern Thailand has been a hub for migration in the Greater Mekong Sub-region, particularly for migrants from Myanmar. HIV prevalence among Myanmar/Burmese migrants is higher than in the general Thai population. This study aims to focus on Shan migrants living with HIV in Chiang Mai, the metropolitan centre of northern Thailand and to examine two related aspects: migrants’ sexual risk behaviour and their HIV knowledge and beliefs. The study aims to understand circumstances in which mobility increases HIV risk behaviour and prevalence.

Using a qualitative study, the authors conducted in-depth interviews in 2017 with 43 HIV-infected Shan migrants (21 males and 22 females), and 29 health-care providers who work in district hospitals in Chiang Mai.

The authors found that social and economic vulnerability associated with migration, and AIDS-related mortality, increased migrants’ likelihood of having multiple serial partners. Confusion about HIV symptoms, stigmatization of HIV positive women and low risk perceptions, particularly among men, increased their risk behaviours.

To the best of the authors’ knowledge, this paper is the first to study the way of life, sexual behaviour and HIV knowledge and beliefs of Shan Migrants from Myanmar Living with HIV in Thailand.

At least 20% of individuals living with HIV pass through prison and jail doors every year, in any nation, worldwide. Therefore, interventions that improve access to HIV testing, HIV care, and education can have a broad impact on public health in every country. The benefits of these interventions in correctional settings have already been well documented. For example, improved access to HIV testing, treatment by an HIV specialist, preventive vaccinations and prophylactic medications, screening for concomitant infections such as HCV, and pre‐release planning services have been shown to decrease HIV‐related mortality and morbidity, to reduce the risk of HIV transmission and to decrease recidivism. Education of at‐risk individuals has also been shown to reduce HIV risk behaviors. Safe distribution of condoms and needle‐exchange programs have also been demonstrated to be safe and effective, although few such programs have been implemented in the United States. While all the available evidence has demonstrated that these public health‐oriented interventions can be and are successful in correctional settings, implementation on a national and international level lags far behind the evidence. The time has come to take an evidence‐based approach to improving HIV management in correctional settings. Implementations of the HIV management interventions described in this article make good medical sense and will have a positive impact on the health of inmates and the communities to which inmates return.

Routine HIV screening of prisoners is generally recommended, but rarely implemented in low-resource settings. Targeted screening can be used as an alternative. Both strategies may provide an opportunity to start HIV treatment but no formal comparisons have been done of these two strategies. The paper aims to discuss these issues.

The authors compared yield and costs of routine and targeted screening in a narcotic prison in Indonesia. Routine HIV screening was done for all incoming prisoners from August 2007-February 2009, after it was switched for budgetary reasons to targeted (“opt-out”) HIV screening of inmates classified as people who inject drugs (PWIDs), and “opt-in” HIV testing for all non-PWIDs.

During routine screening 662 inmates were included. All 115 PWIDs and 93.2 percent of non-PWIDs agreed to be tested, 37.4 percent and 0.4 percent respectively were HIV-positive. During targeted screening (March 2009-October 2010), of 888 inmates who entered prison, 107 reported injecting drug use and were offered HIV testing, of whom 31 (29 percent) chose not to be tested and 25.0 percent of those tested were HIV-positive. Of 781 non-PWIDs, 187 (24 percent) came for testing (opt-in), and 2.1 percent were infected. During targeted screening fewer people admitted drug use (12.0 vs 17.4 percent). Routine screening yielded twice as many HIV-infected subjects (45 vs 23). The estimated cost per detected HIV infection was 338 USD for routine and 263 USD for targeted screening.

In a resource limited setting like Indonesia, routine HIV screening in prison is feasible and more effective than targeted screening, which may be stigmatizing. HIV infections that remain unrecognized can fuel ongoing transmission in prison and lead to unnecessary disease progression and deaths.

Global evidence indicates that multiple structural, biological, and behavioural mechanisms link gender-based violence (GBV), HIV/HCV, and substance misuse among women and adolescent girls. The aim of this chapter is to briefly summarise and synthesise recent literature that examines the complex and bi-directional relationships among these epidemics in different populations of adolescent girls and women around the world. To inform this chapter, a selective search strategy was conducted, prioritising use of meta-analytic epidemiological studies and research on interventions and policies that address different aspects of the syndemic among women and girls who use drugs worldwide. The search targeted publications from 2015 to 2019 using PubMed, MEDLINE, and Google Scholar. The chapter highlights methodological and geographic gaps in existing policy, intervention, and implementation research and makes recommendations for strategies to tackle these gaps. It also identifies a continuum of multilevel evidence-based interventions that target the risk environments and key syndemic mechanisms linking these intersecting epidemics that have been found to be effective in reducing intimate partner violence and other forms of GBV, substance use, and HIV/HCV risks. This chapter also assesses inclusiveness of existing research and interventions for underserved and disproportionately affected populations, affecting adolescent girls, sexual minority women, and racial/ethnic minority women and identifies strategies to target gaps or disparities for these key affected populations. Finally, this chapter describes the gaps and opportunities that harm reduction programmes, medical settings, and other community organisations experience in implementing gender-responsive programmes and policies to redress these intersecting epidemics.